As the coronial inquiry into the Lindt cafe siege draws to a close in Sydney, a litany of police errors have become apparent.
By Mike Seccombe.

The Sydney siege: what went wrong

A hostage flees the Lindt cafe in Martin Place, December 15, 2014.

Credit: AAP Image / Joel Carrett

They are parsing tragedy second by second now in the Coroners Court in Sydney.

It has taken 18 months for the inquest into the Lindt cafe siege to get to this point. It has examined the causal factors – going back almost 20 years – that led up to the 17-hour siege and, ultimately, to three deaths. But this week, they got to the pointy end of the inquiry.

We are finally hearing the evidence of the police who burst in, just a few minutes after Man Haron Monis killed cafe manager Tori Johnson at 2.13am on December 16, 2014. And the court is taking it apart by seconds, even by fractions of seconds.

It took just 33.4 seconds from the time the first of at least 11 flash-bang distractors was thrown into the cafe until the last of them sputtered out. In that short period, two officers fired 22 shots. At the end, Monis was dead.
A second hostage, Katrina Dawson, was fatally wounded. Both were struck by police bullets.

He called in, “White window, two hostage down”, and repeated it. Only then did the tactical operations units get the call to storm the cafe.

Actually, Monis was dead even more quickly than that, according to the first man in, who gave evidence on Wednesday. He was a senior constable with the tactical operations unit, identified only as Alpha Two. His job was to hold a “ballistic shield” to protect members of his team from Monis’s potential gunfire as they burst into the cafe.

When the code word came to go in, Alpha Two said he and his team sprinted from where they had been stationed at a fire door on Phillip Street to the cafe’s main Martin Place entrance. Moving like Usain Bolt, as he said in his written statement. When they reached the doors, he first provided cover for the “breacher” – another officer armed with a shortened shotgun, who fired special rounds to shatter the door.

Even as the glass was falling, Alpha Two went through, closely followed by other police.

He immediately saw Monis – or, in official police language, “identified the person of interest”. There were two flashes of white-yellow light, which he believed came from Monis’s shotgun, held at waist or hip height.

“There’s the cunt,” he shouted. “There’s the cunt. Shoot him.”

The officer close behind him and to his left – Officer A – immediately did.

Looking over the top of his shield, Alpha Two saw the red laser dot from his colleague’s M4 carbine move up from Monis’s chest to his head. There was a burst of shots. Seventeen of them, the inquest had previously heard.

“I watched as his head exploded and he crumpled to the ground,” Alpha Two said.

Monis killed

It couldn’t have happened any more quickly, he said this week. It was over in seconds. Indeed, in a statement given shortly after the event, he said “milliseconds”.

Monis was dead and yet the police action was continuing. Flash-bangs were still going off. One hit Alpha Two’s helmet. He recalled at that moment he might have shouted “something to the effect” of: “The cunt’s down. The cunt’s down.”

One of his team was down also. That was Officer B, who also fired five shots. Alpha Two said he didn’t see the officer fall, but thought he recalled hearing someone say, “Officer down.” He ordered: “Get up. Get the fuck up.”

When the shooting finished, he was still giving orders. There were hostages to be moved, and some were injured.

“Get some fucking medics. We need some fucking medics in here.”

With Officer A, he went to where Monis lay. He had no doubt Monis was dead, because he was “missing half his head”.

To Officer A, he said: “Mate, we’ve got to fucking move this cunt.” And they dragged the body maybe two or three metres.

It was not clear why they did this, but what was clear to those hearing Alpha Two’s evidence was that he was a take-charge kind of guy – tough talking, confident in his own judgements, clear about his role in confronting the self-professed Daesh terrorist armed with a shotgun and possibly a bomb in his backpack.

And he was refreshingly prompt and direct in his answers in the Coroners Court, as well he might be, given that his role was one part of the operation that had gone efficiently and smoothly.

Delayed entry

So many other witnesses have hedged and rationalised their way through their evidence. So much else did not go smoothly.

Example: three tactical operations teams were supposed to enter the cafe simultaneously. But things did not go to plan.

The day before Alpha Two appeared at the inquest, the leader of another of the teams – pseudonym Delta Alpha – was questioned about a delay in entering the cafe, after one of their flash-bang devices was thrown into a closed door and bounced back at them.

CCTV showed members of the team reeling back, apparently disoriented by the explosion of sound and light from the device.

By the reckoning of counsel for Katrina Dawson’s family, Michael O’Connell, SC, it took them 21 seconds to travel the few metres from a fire escape through the unlocked doors of the cafe. According to Ian Freckelton, QC, for the NSW Police Force, it was only 19 seconds.

In either case, the lost time was of the essence, said O’Connell, given that Monis had just killed a hostage and the objective was to stop him executing anyone else.

Had that team got there first, they would have engaged Monis from a different angle. The suggestion was that Ms Dawson might not have died.

“There was a hostage who died as a result of police firing at Monis,” O’Connell said. “You understand that. What I am suggesting to you is that if Charlie and Delta [teams had] been in there earlier, that might have changed the outcome.”

It wasn’t really a question and it didn’t get an answer. The matter was imponderable, as Coroner Michael Barnes pointed out.

But the fact remains: it was one thing that had gone wrong in the operation.

Comms truck not in service

Another example: a radio failure just as the decision was made to go in prevented the tactical commander from giving the order to the teams on the ground outside the cafe.

It only delayed things by a matter of seconds, before his deputy was able to give the order. But, again, time was of the essence.

The deputy said there had been radio problems intermittently throughout the day and night.

“Murphy’s law is it always happens at a critical time,” he told the coroner.

Murphy’s law, though, applies to bad luck. The communication problems that dogged the siege response were attributable to more than bad luck.

A senior negotiator told the inquest his team’s efforts were hampered by the fact that a specialist truck, equipped with soundproof booths, whiteboards and sophisticated communications equipment, was not available.

It had not been available since 2011, when it was badly damaged in a crash. It was subsequently sold and had never been replaced.

In its absence, negotiators worked for the first few hours of the siege from a four-wheel-drive vehicle, before moving to an office at a close-by leagues club. There were no whiteboards and only a single phone line. Some calls from hostages were diverted to another area in the club, rather than to the negotiators’ mobile phones.

Attempts were made to record the conversations on a dictaphone, but several hours of calls went missing. The primary negotiator, “Peter”, said he was not good with technology.

He had no direct access to a listening device inside the cafe, nor to information passed on by the hostages who escaped at various times through the afternoon and evening. He was reliant on information passed on by other officers. He said he was sure they would have told him if “anything important” happened. He had no direct access to police databases on which information was being shared.

Peter had never before worked in a hostage situation but had done a counterterrorism course that involved Islamic extremism and role-playing with colleagues. Asked why he was picked for the job, he offered only that his team leader, “Reg”, had said, “ You go primary.”

Reg, for his part, had started negotiation training in 1998 and completed about four weeks spread over several years.

He had never dealt with a situation involving more than three hostages, having worked mostly on cases of domestic disturbance and with some kidnappings and suicides. He had completed a short course on understanding Islam.

Snipers were placed in three locations near the cafe – at Channel Seven, Westpac and the Reserve Bank, but they too had communication problems and other concerns, foremost among them the fact they were behind heavy glass.

Shooting through two lots of glass, the one close in front and then the windows of the cafe, greatly diminished the chances of an accurate shot.

And a miss, the tactical commander who was in charge of them said, could have been “catastrophic”, had Monis then retaliated.

There were few options for a clear shot, anyway. And there was also the legal problem.

As the tactical commander during the operation – among many others – told the inquest: the trigger for action was death or serious injury to a hostage, or the imminent threat of death or injury. This applied to the snipers as much as to any other officer.

The fact that Monis made threats to kill did not meet the criteria. Nor did his extensive criminal history, which included sexual assaults and being an accessory to the murder of his former wife. The evidence from within the cafe and from hostages who escaped that Monis was becoming increasingly agitated was also deemed insufficient.

Although plans had been laid for an emergency action, the police approach continued to be one of “contain and negotiate”. Yet they never made direct contact with Monis to negotiate. He communicated only through the hostages.

Storming the cafe

Assistant Commissioner Mark Jenkins, who took command of the siege about 10pm, said he had been briefed that the mood inside the cafe was casual, even “jovial”. He remained confident the siege would be resolved peacefully.

He and other senior officers were comforted in that view by a psychiatrist, who cannot be named. The psychiatrist opined that Monis was a narcissist driven by a “grandiose” need for recognition, but did not fit the profile of a terrorist. The “human behaviour specialist” did not believe Monis would kill.

And so the “contain and negotiate” strategy drifted on.

Even at 2.03am, when Monis fired his gun after six fleeing hostages, it was taken as a warning shot.

Down in the doorway on Phillip Street, though, where Alpha Two was waiting with his shield, he knew things had “turned real”.

Meanwhile, up above, the snipers were watching.

One told of seeing the hostages escape and then, about 2.05 or 2.06, seeing the cafe manager, Tori Johnson, walk towards a window and go to his knees. He went down one leg at a time, then locked his fingers on the top of his head.

Johnson was visible in profile; Monis was not.

At first, the sniper thought the intent was to stop Johnson escaping, like the others. It was a “control position”, as military and law enforcement personnel use around the world, he said.

He saw a muzzle flash. Johnson flinched and dropped from sight. The sniper thought Johnson had been shot. But then Johnson resumed kneeling.

The sniper, Sierra 3-1, told the inquest he was confident he had reported what was happening on his radio. But there was no acknowledgment.

A second sniper observed Johnson on his knees for about 30 seconds before the fatal shot. He called in, “White window, two hostage down”, and repeated it.

Only then did the tactical operations units get the call to storm the cafe.

Again, time was of the essence. If the recollection of the first sniper is accurate, there was an imminent threat for maybe seven minutes. If the shooters had moved earlier it might, to borrow a phrase from Michael O’Connell, SC, have changed the outcome.

Tactical commander’s criticism

In the peanut gallery of the Coroners Court press room – unable to see the faces of the witnesses, or hear what is said in the frequent closed sessions, or scrutinise the various statements and reports, and constrained by the scores of non-publication orders, covering everything from the identities of witnesses to trivia such as the dimensions of Alpha Two’s shield – we are really in no position to judge.

But at least a couple of high-ranking police have expressed concern about the way things were allowed to drift, to the point where emergency action became the only option.

The most senior of them, the tactical commander during the siege, told the inquest it would have been better to embark on deliberate action. A planned assault on the cafe at a time chosen by the police would have entailed less risk than an emergency action, forced by Monis’s actions.

And O’Connell, for the family of Katrina Dawson, has indicated he will also submit that deliberate action would have been better.

We’ll have to wait and see what Coroner Barnes finds at the end of his investigation, having viewed the 1000-odd written statements, heard the evidence of the scores of witnesses, and reviewed the hundreds of hours of CCTV media and 3D computer re-creations.

It is a massive task, determining what might have been done better by authorities in Australia’s first major domestic terrorist incident.

It is not the coroner’s role to apportion blame, but blame will inevitably attach, and so will politics, for the senior ranks of the NSW Police Force are acutely political.

Premier Mike Baird was effusive in his praise of Commissioner Andrew Scipione and his likely successor, Catherine Burn, over their role in events immediately after the siege.

Their input, at least in an operational sense, was zero, according to their lawyer. They gave no orders and no advice. Yet Burn was titular head of counterterrorism.

One might ask why she was not involved. Lawyers for the families of the dead hostages, in particular, would like to know.

No decision has been made on whether they will be called on to account for their actions. Or lack of action.

In the meantime, there is still quite a bit more to be heard about what went on inside the cafe. We are yet to hear from Officers A and B, the men who fired the shots that brought the siege to an end that tragic early morning.

Their appearances, the week after next, will likely be highly charged. Their bullets not only killed Monis; fragments also killed Katrina Dawson and wounded others, including Officer B himself.

Their actions, committed in the heat of a few brief moments, will be coolly dissected by lawyers, second by second.

This article was first published in the print edition of The Saturday Paper on
Jul 16, 2016 as "The Sydney siege: what went wrong".
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